The recent U.S. Supreme Court 5-4 decision upholding that the Patient Protection and Affordable Care Act -a/k/a “Obamacare”- is constitutional has been both praised and vilified. The non-partisan Kaiser Family Foundation claims that health care costs will be curbed when the law’s provisions become fully effective in 2014. Conversely, a partner with a New York City law firm specializing in employer benefit plans says, “As more of the requirements [of health care reform] develop, the cost of insurance will go up.”
So, which is it? As the Nobel laureate economist Milton Freeman wrote, “There’s no such thing as a free lunch.”
Rhode Island’s left-leaning Congressional delegation was delighted with the court’s decision. Embattled Rep. David Ciccilline proclaimed the Supreme Court ruling as the first step toward a government, single-payer health care system.
On June 28th Chief Justice John Roberts of the Supreme Court of the United States, writing for himself and the 4 judicial activists on the bench said a penalty is a tax and therefore comes under Congress’ power to impose taxes. And you thought President Bill Clinton could parse words when he said. “It depends on what the meaning of ‘is’ is.”
Chief Justice John Roberts decided a penalty is a tax if is going to be enforced by the IRS. Presumably this is why Obamacare will fund the hiring of tens of thousands of new IRS agents and employees.
Three days later, on three different Sunday morning gasbag shows, Jack Lew, Obama’s chief of staff, stated, “the penalty for failure to buy health insurance is not a tax, no matter what people are saying…”
Rather than declare the Patient Protection and Affordable Health Care Act unconstitutional and sending it back to Congress as Justices Scalia, Thomas, Alito and Kennedy wanted, the activist wing of the Supreme Court plus the chief justice rewrote the law so it fit under the “Commerce Clause” of the Constitution.
A syndicated columnist for the state’s largest daily newspaper wrote a specious defense of government forcing citizens to buy something by quoting a Harvard Law School professor that in 1790 the first Congress mandated that merchant ship owners had to purchase medical insurance for their seamen. Ordering companies to insure their workers is a far cry from mandating that the seamen buy insurance or else pay a penalty –or would it be a tax?
Apparently, the Federal government can now force us –the citizens- to do or buy anything it deems desirable or necessary and impose a tax if we chose not to do so. In fact, Obamacare includes increases in 12 existing taxes and 23 new taxes. Progressives, of course, argue that these taxes will be imposed only on “the rich.”
Representative Alan West (R-Fla.) observed that a future Congress might decide that to protect themselves from crime, every adult citizen must buy a handgun. Failure to do so would result in a tax –or would it be a penalty?
One thing should be clear. Obamacare will profoundly affect the way health care is delivered everywhere –including Rhode Island.
In April 2008 I wrote: “In Massachusetts, which enacted a form of universal health care, general practitioners report being overwhelmed by new patients coming to their offices with relatively minor illnesses. The result is someone wanting an annual physical exam (which is supposed to be a lynchpin of preventive health care) must schedule over a year ahead. What happens if someone has to cancel his or her appointment? Do they have to wait another year?”
After the Supreme Court’s ruling a representative of a physician’s group observed that the country will need 90,000 more primary care doctors when Obamacare is fully implemented. This means that you will see more physicians’ assistants and nurse practitioners rather than a medical doctor. Registered Nurses (RNs) will also be in short supply, he said. This means you will see more “technicians” in the hospital rather than RNs.
A fifteen-member commission, none of whom have to be health care professionals, will be appointed to run the whole program.
A neurosurgeon who was driving back from a conference last November called the Mark Levin radio show. He reported that under Obamacare patients would be referred to as “units.” This doctor said that he would not be allowed to perform life saving surgery on a unit over 70 years of age until the panel of administrators gives the OK. So, if you suffer a stroke at 2 a.m. and you are 70 years old you will be either dead or severely disabled. And liberals howled when Sara Palin talked about “death panels.”
Obamacare’s supporters point out that health care reform means more Americans will be insured by their employers, who will be penalized –or is it taxed, for not providing health insurance for “essential services.” Keep in mind that the Obama administration has granted over 1,400 exemptions from the employer mandate, most of them to labor unions. Obamacare also contains a $9 billion slush fund to shore up underfunded union health care plans for retirees.
However, essential services under Obamacare are undefined but include rehabilitative and “habilitative” services. No one yet knows what the latter is. Health insurance companies have said that they need to know what essential services are in order to design policies that comply.
In addition, these policies and their cost are needed for the so-called state insurance exchanges touted by Gov. Chafee and Lt. Gov. Roberts. These exchanges are where Rhode Islanders are supposed to purchase an individual health insurance policy.
This subsidy is supposed to drive down the cost of health care because those without health insurance will no longer have to go to emergency rooms for treatment, the cost of which is then passed on to those of us with insurance. When progressives say health care will be made affordable they mean the government will tax “the rich” to provide health insurance for “the poor.” And no mention of the fact that this program will be administered by a huge bureaucracy that “the rich” will be taxed to pay for.
Previously I wrote, “Left-wing film maker and polemist Michael Moore made a movie lauding the universal Cuban health care system. Has anyone read a news report talking about all the sick people going to Cuba to take advantage of this marvelous care? How many Canadians cross the border to seek care here rather than wait long periods of time for treatment that here would be considered routine but in Canada are deemed to be elective?”
If Obamacare is not repealed there is no way it can be fully implemented without a degradation of the delivery of health care or increases in its cost. The economic law of supply and demand is inexorable no matter how much progressives want it declared unconstitutional.

Richard August is a North Kingstown resident and a regular contributor to the Standard Times. He served for six years on North Kingstown’s Audit Committee and was its chairman for the last two. His opinions are his own.